Tomoko Tanahashi

Combination of patch test and IgE for dust mite antigens differentiates 130 patients with atopic dermatitis into four groups

BACKGROUND Patients with atopic dermatitis sometimes have positive responses to patch testing (PT) with dust mite antigens, which is believed to correlate with the elevated levels of specific IgE for those antigens. OBJECTIVE The purpose of this study is to identify the correlation between the PT and serum IgE concerning the mite antigens. METHODS We studied 130 patients with atopic dermatitis by the PT reaction and the serum level of specific IgE for Dermatophagoides pteronyssinus antigens. RESULTS Fifty-one of the 130 patients assessed as PT-positive had either high (32 of 130 patients; 24.6%) or low or no (19 of 130 patients; 14.6%) levels of mite-specific IgE; there was a significant difference between the groups with elevated and low IgE. Similarly, a total of 79 PT-negative patients also showed an elevated or low mite-specific IgE (42 of 130 patients [32.3%] or 37 of 130 patients [28.5%], respectively). It was noted that clinical morphologic findings were peculiar to three of the four groups; however, the patients who were PT-negative with a low IgE (37 of 130 patients) showed no particular clinical lesions. CONCLUSION Comparing the results from our 130 patients, there was no correlation between the serum IgE level and the PT reaction for dust mite antigens. Conversely, the results of PT and mite-specific IgE could be used to divide these patients into four distinct groups, each with its own particular clinical morphology, suggesting the heterogeneity of this disease.

Sulfidoleukotriene Release Test (CAST) in Hypersensitivity to Nonsteroidal Anti-Inflammatory Drugs

There is a great need to develop a method for making an accurate and reliable in vitro diagnosis of adverse hypersensitivity reactions to drugs. We measured the amount of sulfidoleukotriene (sLT) released from the peripheral blood leukocytes obtained from 25 patients who developed hypersensitivity reactions following the administration of nonsteroidal anti-inflammatory drugs (NSAIDs); 12 patients demonstrated reactions to Voltaren, 8 patients to Bufferin, and 5 patients to Sedes G. The stimulation index, the ratio of the amounts of sLT (pg/ml) incubated with and without drugs, was considerably higher in the patients than in the controls, which consisted of 5 nonallergic healthy subjects. The sensitivity of the CAST (cellular antigen stimulation test) was evaluated to range from 62.5 to 80%, while the specificity was 70-100%. The CAST may thus be useful as a novel in vitro test system in order to screen for possible hypersensitive reactions to NSAIDs with both reliability and safety.

Comparison between famciclovir and valacyclovir for acute pain in adult Japanese immunocompetent patients with herpes zoster.

Famciclovir is a guanine analog antiviral drug used commonly for herpes zoster. Efficacy of famciclovir treatment has been reported to be comparable to valacyclovir treatment. Both of these medications reduce the time to complete cessation of zoster‐associated pain including post‐herpetic neuralgia, as compared to acyclovir. We conducted a multicenter, randomized, open clinical trial in order to evaluate the extent of pain relief afforded by these two antiviral drugs during the acute disease phase of herpes zoster. The study group comprised 86 immunocompetent adult patients suffering from herpes zoster, who were treated with either famciclovir or valacyclovir for 7 days. Of these, 55 patients enrolled in this study within 72 h of the onset of the rash and 31 patients after 72 h of the onset. There was a significant reduction in acute herpes zoster pain with famciclovir on day 7 and at 2–3 weeks in both of these patient groups, while with valacyclovir, there was not significant reduction in pain on day 7. Of patients aged 50 years or older, there was a significantly earlier reduction in pain with famciclovir than with valacyclovir. In addition, a significant reduction in the number of patients with pain was observed as early as days 3–4 with famciclovir treatment as compared with valacyclovir treatment. We conclude that famciclovir was superior to valacyclovir in the relief of acute pain of herpes zoster. Accordingly, famciclovir is recommended for herpes zoster patients with moderate symptoms and a visual analog scale score of under 50 mm.